Requires health insurance policies to provide coverage of both inpatient and outpatient opioid addiction treatment services

Summary of provisions

Section One - amends Section 3216 of the insurance law by adding a new paragraph 30 to state that every policy delivered or issued in New York state that provides major medical or similar comprehensive type coverage will include coverage for both inpatient and outpatient opioid addiction services that are provided by a qualified health professional, as defined in the regulations of the commissioner of alcoholism and substance abuse.

Section One - states the only prerequisite for the coverage of hospital or non-hospital based opioid addiction services, including medically managed, medically supervised and medically monitored withdrawal, or inpatient or intensive residential rehabilitation, or intensive or routine outpatient treatment will be that a covered person be certified and referred by a qualified health professional. Such certification and referral will control both the nature and duration of covered treatment; provided, however, that such coverage will be terminated when the admitting or attending physician, or a physician assistant or nurse practitioner acting under the supervision of a physician, providing opioid addiction services, rehabilitation or outpatient treatment certifies that admission of the covered person is not necessary, early discharge is appropriate or additional inpatient days or sessions are necessary.

Section Two - amends Section 3221 of the insurance law by adding a new paragraph 19 to state that every group or blanket policy delivered or issued for delivery in this state that provides major medical or similar comprehensive type coverage will include coverage for both inpatient and outpatient opioid addiction services that are provided by a qualified health professional, as defined in the regulations of the commissioner of alcoholism and substance abuse services.

Section Two - states the only prerequisite for the coverage of hospital or non-hospital based opioid addiction services, including medically managed, medically supervised and medically monitored withdrawal, or inpatient or intensive residential rehabilitation, or intensive or routine outpatient treatment will be that a covered person be certified and referred by a qualified health professional. Such certification and referral will control both the nature and duration of covered treatment; provided, however, that such coverage will be terminated when the admitting or attending physician, or a physician assistant or nurse practitioner acting under the supervision of a physician, providing opioid addiction services, rehabilitation or outpatient treatment certifies that admission of the covered person is not necessary, early discharge is appropriate or additional inpatient days or sessions are necessary.

Section Three - amends Section 4303 of the insurance law by adding a new subsection (oo) to state every contract issued by a hospital service company or health service corporation which provides major medical or similar comprehensive type coverage will include coverage for both impatient and outpatient opioid addiction services that are provided by a qualified health professional, as defined in the regulations of the commissioner of alcoholism and substance abuse services.

Section Three - states the only prerequisite for the coverage of hospital or non-hospital based opioid addiction services, including medically managed, medically supervised and medically monitored withdrawal, or inpatient or intensive residential rehabilitation, or intensive or routine outpatient treatment will be that a covered person be certified and referred by a qualified health professional. Such certification and referral will control both the nature and duration of covered treatment; provided, however, that such coverage will be terminated when the admitting or attending physician, or a physician assistant or nurse practitioner acting under the supervision of a physician, providing opioid addiction services, rehabilitation or outpatient treatment certifies that admission of the covered person is not necessary, early discharge is appropriate or additional inpatient days or sessions are necessary.

Section Four - this act will take effect on the thirtieth day after it has become law.

Justification

Heroin use is on the rise throughout New York State - an alarming trend that transcends regions, race, gender and economic status. The New York State legislature cannot turn a blind eye to this deadly epidemic, and it is time to be proactive and develop a comprehensive solution.

To combat this scourge, we need to join together and discover new preventative measures, while expanding and improving the treatment options for those suffering from opioid addiction. When an individual suffering from an opioid addiction makes the decision to get help, there is a window to provide them with the care and assistance they need to have a successful recovery.

In certain cases, a qualified health care professional will require an individual to be admitted as an inpatient to be able to get the proper help they need to fight an opioid addiction. This legislation would successfully enable a request to be made by a qualified health care professional and require health insurance coverage of an individual requiring inpatient services, to receive the medical assistance for proper treatment of an opioid addiction before it is too late.

Often times insurance companies require an individual to try outpatient treatment before they can be admitted as an inpatient. That requirement by insurance companies shortens the little window time the individual has to get better and defeat their addiction. By requiring inpatient treatment immediately, that gap of wasted time spent receiving outpatient treatment is eliminated. Getting an individual in the care of a professional as soon as possible is vital to the defeat of the addiction.

Legislative history

New Legislation.

Fiscal implications

None.

Effective date

This act shall take effect on the thirtieth day after it shall have become a law.